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Global Financing Facility in support of Every Woman Every Child
CSO Consultation, November 14 2015
• Reduction in <5 mortality rate: from 90 deaths per 1,000 live births in 1990 to 46 in 2013
• Reduction in MMR: from 380 deaths per 100,000 live births in 1990 to 210 deaths in 2013
Significant progress but much remains to be done
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1990 1995 2000 2005 2010 2015
Under-five mortality rate (per 1,000 live births)
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1990 1995 2000 2005 2010 2015
Maternal mortality ratio (deaths per 100,000 live births)
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Every Woman Every Child Global Strategy
• Action areas – Country leadership – Financing for health – Health systems
resilience – Individual potential – Community
engagement – Multisector action – Humanitarian and
fragile settings – Research and
innovation – Accountability
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GFF is a financing partnership in support of EWEC and country leadership
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The big picture: ODA is declining as a share of financing flows to developing countries
…and financing to health from domestic sources – both public and private – increasingly dwarves international contributions
• Private expenditure on health is >50% of total health expenditure in more than 60% of GFF countries
Sources: OECD, NHAs
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GFF timeline
UNGA New York
NGO Consultations
Business Plan completed
Spring Meetings Washington, DC World Health
Assembly Geneva
FfD Addis Ababa, Ethiopia
SEP 2014
OCT 2014
DEC 2014
FEB 2015
APR 2015
MAY 2015
JUL 2015
SEP 2015
GFF launch, including 2nd wave countries
BUSINESS PLANNING OPERATIONAL PLANNING & SETUP
FINANCING COMMITMENTS COUNTRY & STAKEHOLDER CONSULTATIONS
GFF announcement
EWEC launch; 1st Investors
Group
OPERATIONS
Process supported by multi-stakeholder Oversight Group & Business Planning Team
Countries leading the way
• Frontrunners: DRC, Ethiopia, Kenya and Tanzania • Second wave: Bangladesh, Cameroon, India, Liberia,
Mozambique, Nigeria, Senegal, and Uganda
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Bridging the funding gap for women’s, adolescents’, and children’s health
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The combined effects would prevent 24-38 million deaths of women, adolescents, and children by 2030
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Overview of the GFF
Smart
Scaled
Sustainable
Results
1. Investment Cases for RMNCAH
2. Mobilization of financing for Investment Cases
3. Health financing strategies
4. Global public goods
The “what” of the GFF The “how” of the GFF The “who” of the GFF
The GFF as a broader facility
The GFF Trust Fund
Governance
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1. Scope of Investment Cases
Clinical service delivery and preventive interventions
Health systems strengthening
Multisectoral approaches
End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents
Serv
ice
deliv
ery
appr
oach
es
CRVS
Equity, gender, and rights Mainstreamed across areas
• Prioritizes interventions with a strong evidence base demonstrating impact • Emphasizes issues (e.g., family planning, nutrition) and target populations (e.g.,
adolescents) that have been historically underinvested in • Further focuses on improved service delivery to ensure an efficient national
response (e.g., through task-shifting, integration of service delivery, community health workers, private sector service delivery environment)
Investment Case road-map
• Roles • Timeline • Milestones • Potential TA
needs • Agreement
on country platform
Situation analysis • Equity • Sub-national
differences • Efficiency • Multisectoral
determinants • Upcoming
structural shifts
Costed options and resource map • Costed set of
interventions and strategies (including multisectoral components)
• RMNCAH resource landscape by program, location and partner
Prioritized Investment Case • Set of priority
interventions/strategies that fit within available resources
• If appropriate, scenario analysis with different sets of interventions and strategies based on different scenarios of resource availability
• Results framework with plans for monitoring and evaluation
Commitments and alignment to Investment Case • High level
agreement on co-financing between government and partners, and within government between ministries of health and finance
Costing, cost-effectiveness
, and resource mapping
Approach to Investment
Case development
Impl
emen
t
Core set of interventions and strategies • Agreement on
2030 targets and 5 year milestones
• Identification of priority high-impact interventions
• Core strategies to address system bottlenecks
• Multi-sector interventions including CRVS
1. Overview of process and outputs towards a quality Investment Case
Results and key interventions and strategies
Agreement on repartition of financing for
the Investment Case
Core analytics Prioritization
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2. Quality Investment Cases with aligned financing drive results
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Nat
iona
l str
ateg
ic fr
amew
ork(
s)
Investment Case
Government
Donor 1
GFF Trust Fund +
IDA/IBRD
Gavi, Global Fund, other multilateral
Donor 2 Donor
1
Donor 3
Private sector
Government
The Investment Case sharpens the focus on evidence-based, high impact interventions while reducing gaps and overlaps as financiers increase funding for RMNCAH
2. Repartition of financing
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Inve
stm
ent C
ase
Government
Donor 1
GFF Trust Fund +
IDA/IBRD
Gavi, Global Fund, other multilateral
Repartition of financing will not occur automatically: requires dialogue between ministries of health and of finance, and among external financiers
1. Institutionalization of priorities (e.g., in budgets and MTEFs) requires sustained dialogue between ministries of health and of finance
2. Many key donors have expressed willingness to support Investment Cases, but achieving this requires sustained dialogue at the country level
3. Health financing strategies
• Objective: help countries develop and implement strategies to build sustainable health financing systems and thus attain their health financing goals
• Scope: Health sector-wide • Timeframe: through 2030 • Key issues being addressed:
– Defining right to health as an entitlement
– Increasing domestic resources for health
– Improving efficiency – Improving coordination of
development assistance – Reducing inequities
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Strategy development
Strategy implementation
including capacity building
Health financing system assessment
GFF Trust Fund
• Grant resources linked to IDA/IBRD financing – US$875 million pledged to date from Canada, Norway, and the Gates
Foundation
• Country selection: – Eligibility: 62 low and lower-middle income countries
• Must be willing to commit to increasing domestic resource mobilization and interested in using IDA/IBRD for RMNCAH
– Initial set of 12 countries mentioned earlier
• Resource allocation: – Range of US$10 to 60 million per country (grant funding only, not
including IDA/IBRD) • Based on need, population, and income
– Expected ratio of 1:4 for trust fund:IDA (on average, not in every country)
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GFF governance at the country level: the country platform
• Preparation and finalization of Investment Case and health financing strategies
• Complementary financing
• Coordination of technical assistance and implementation support
• Coordination of monitoring and evaluation
• Not prescriptive about form
• Build on existing structures while ensuring that these embody two key principles: inclusiveness and transparency
• Diversity in frontrunner countries: • Ethiopia and Tanzania
used existing structures • Kenya established a new
national steering committee
• Government • Civil society (not-
for-profit) • Private sector • Affected
populations • Multilateral and
bilateral agencies • Technical agencies
(H4+ and others)
Approach Partners Roles
GFF governance at the global level
• GFF Investors Group: – Members: 23 representatives of developing and developed
countries, multilateral organizations, foundations, civil society, private sector
– Role: governance for the facility, including ensuring effective co-financing of Investment Cases; not decision-making on individual Investment Cases
• Trust Fund Committee:
– Members: key donors to trust fund – Role: governance of the trust fund resources, including
decision-making on selection of countries and allocations to countries
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Sources of Financing - IBRD, IDA, Trust Funds
•To countries with a per capita income (GNI) of US$1,215 or more (FY16). • IBRD can finance IPF, PforR, DPF •Borrowers have a range of options with respect to repayment terms and currencies
IBRD
•Cut off per capita income less than US$1,215. An exceptions on a temporary basis for selected countries, such as: • Countries undertaking major adjustment efforts but are not creditworthy for IBRD financing • Small island economies that lack creditworthiness
•The repayment period for IDA credits varies from 25 to 40 years depending, with a 5 to 10 year grace period
•Low income debt-distressed countries may qualify to receive all or part of their IDA financing on grant terms
IDA
•Bank operations can be financed through Recipient-executed trust funds (RETFs) that are administered by the Bank but executed by a third party (a recipient/client).
•RETFs generally are provided to the recipient on a grant basis. The Bank charges a fee to recover its costs.
Trust Funds
IDA : All you need to know in two (crowded!) slides • Currently supports 77 countries (plus India) – 39 of these
countries are in Africa [2.8 billion of the world’s poor] • Single largest source of funding for basic social services in
these countries • About 65% of IDA funds come from donor contributions
(other: IBRD, IFC, previous IDA repayments) • Since donor funds are pooled, IDA can leverage a large capital
base that is un-earmarked • IDA 17 is from FY14-FY 17 and attracted a record $52 billion • IDA is there for the long haul – long term development • Global leader in transparency
– Undergoes the toughest independent evaluations of any international organization
– “smart’ funding (UK, Australia, CGD)
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IDA : All you need to know in two (crowded!) slides • IDA allocation to a country is based on
– Country’s relative poverty • GNI per capita • lack of creditworthiness to borrow in the markets)
– Policy and institutional assessment • Promote economic growth • Reduce poverty
– Country performance • Portfolio performance
– Other • Per capita income • Population size • For IDA 17, 50% of funding should go to Sub-Saharan Africa, warranted on
performance
• Allocation of IDA within a country’s envelope is through the CPF
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Relationship between IDA and GFF Trust Fund
No separate application process for GFF Trust Fund – Fully integrated within Bank operations – uses the same
operational and administrative processes (low management costs)
– Linked to IDA/IBRD operations that support RMNCAH – Uses Bank expertise across entire World Bank Group including
IFC – Uses same operational and administrative processes – Builds on the experience and management capacity of the
existing Health Results Innovation Trust Fund
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